Having a complete set of medical records significantly improves the quality of health care for a patient by establishing a patient's medical baseline and indicating patterns in the patient's medical history. These records provide information impacted by time and by the diversity of medical view points and knowledge gained from clinical tests. Having a comprehensive set of data that goes back in time and that is inclusive of observations and findings from multiple providers who have seen or treated the patient over time makes a difference in the quality of the information used to accurately diagnose and treat medical problems. This is especially true for medical problems in the early stages of development. Patient records, when consolidated and complete, often show identifiable patterns of symptoms, diagnoses, treatments and responses to those treatments over the life of the patient. When new health issues arise, or an old one recurs, the information and patterns contained in the medical records can help guide health professionals in making new diagnoses and in their choices for treatments. Each patient's baseline medical information is unique. Many people exhibit unusual readings on some medical tests as part of their normal healthy baseline state, even though those same readings might be considered unhealthy when considered in isolation. In the context of the patient's past history, these unusual readings become part of the patient's baseline, and the repetition of those unusual readings over time is not a major concern. However, in the absence of the patient's historical baseline information, these unusual test results could provoke misunderstandings or over-reactions from doctor(s) not familiar with the patient's history. The risk of medical errors can be significantly reduced by providing patient-specific information to doctors currently diagnosing or treating the patient about the patient's adverse effects of past treatments, allergic reactions to certain drugs, and general disposition to certain diseases or health conditions. In addition, part of a patient's medical history can include their family medical history. Historical family records of medical conditions can help determine a patient's level or risks for certain medical conditions, such as heart disease, diabetes, and breast cancer, and can alert health care providers when increased screening and other tests are advisable.
In the past, when a patient generally had one or a handful of doctors for most of his life, the doctor(s) more often had records and knowledge of the patient's complete medical history. In today's world, a number of economic forces and trends in health care are contributing to the increasing fragmentation of patient records across multiple providers, and to increasing discontinuity in the knowledge of the patient's medical history by the patient's doctors over time. Examples of these trends include the increasing frequency with which patients change medical insurance and jobs, move residences, and are being referred to health care specialists. In addition, it is now more common for patients to consult with multiple doctors and specialists for treatment alternatives and second opinions. On the provider side of the health care industry, there is a growing trend toward increased specialization on the part of doctors. Also, in response to economic pressures and wide-spread disruptions in the health care industry caused by business insolvency, poor operating results, and by increasing frustrations with unpopular reimbursement policies and cost-cutting practices of hospitals, Health Maintenance Organizations (HMOs), and other health care groups, doctors have become more resolved to close practices or switch their allegiance to business practices and affiliations. When they do switch, patients often need to find new doctors or organizations to provide them care. Today's patient typically sees many more healthcare providers over his lifetime than was the case in previous generations.
Each healthcare provider is concerned with the maintenance and/or restoration of the health of the body and/or mind of the patient. The health care provider may be one person (e.g., sole practitioner), a group of persons (e.g., a family clinic), or an organization (e.g., hospital or medical university) that for legal and billing reasons, is the author, owner, and custodian of only that portion of a patient's medical records corresponding to the diagnosis or treatment that the healthcare provider provides to the patient. For today's patient, there is very seldom a single provider who would have all the records of the patient's other providers, past and present. Moreover, because patient's medical records are typically paper-based records, the healthcare provider incurs overhead costs in maintaining and storing them. This creates an economic incentive for each healthcare provider to try to minimize the records it keeps to only those records pertaining to the portion of the patient's care that the healthcare provider itself has provided. When the healthcare provider requires access to other portions of the patient's medical records (i.e., information about the patient authored by other healthcare providers), requesting-physicians typically only request and retrieve from these other health care providers medical records that are of immediate relevance to them. Hence only a subset, rather than a complete set, of a patient's medical records are kept by a health care provider in order to minimize the additional storage and other administrative costs. For the same economic reasons, a healthcare provider typically discards a patient's medical records, after the patient becomes inactive under that provider's care for a legally specified time, e.g., 5 to 7 years.
From the record sending side, there are problems in performing the transfer of medical records between healthcare providers. There is also an economic disincentive and therefore a reluctance or a slow reaction for the healthcare provider holding the patient's medical records to transfer copies of a patient's records to other providers because the costs of retrieval, copying, and mailing are traditionally born by the sending-physician as a common courtesy to the receiving-physician. To help keep these costs down, the tasks of administering, copying, and mailing record copies are often performed only during slow periods or during lulls in other activities of the medical office staff. The relatively low priority assigned to providing copies of medical records often results in long delays between the request for and the delivery of patient records, even when disclosure is legally authorized and record copies required to be released.
Upon receipt, the receiving-providers often need to reorganize the paper records according to their own system of record-keeping. While the increased use of electronic medical records (EMRs) over paper-based records has reduced the storage cost, paper-based records are still prevalent. Over 80% of patients' medical record information still exist in paper formats. Doctors continue to make handwritten notes of their diagnoses and treatments. In addition, today when records are kept in electronic form in an Electronic Medical Record (EMR) system, records are still commonly transmitted between doctors in hard copy, paper-format. This is true even when both doctors have access to different EMR systems because such systems are rarely compatible with each other. When the transfer of patient information is between one computer application and another, the computer applications maintaining the electronic medical records typically differ between health care providers. So, if it is deemed necessary to convert paper records into electronic format for information consolidation and processing, the receiving-provider would have to bear the cost of converting records to electronic format, including record storage costs and the ongoing costs of creating scanned images of paper-based records. Rather than converting records from sending-providers into electronic format, or from sending-providers' electronic format to paper-based and then to the receiving-providers' electronic format, today's common practice is for recipient-providers to simply review the paper copies of records received and file them away with the rest of the patient's paper-based records providers.
Thus, because each healthcare provider typically keeps their own medical records of the patient and because there is little actual sharing or records between healthcare providers, the result is a fragmentation of a patient's medical records across the multiple healthcare providers. In effect each healthcare provider becomes a part of a puzzle of the patient's medical history, and no healthcare provider sees the whole picture. This fragmentation of information about the patient is further exacerbated by the patient's increasing use of specialists and increasing need to switch health insurance plans and healthcare providers in order to pursue better care or to reduce cost of the premium. The increase in providers seen in the context of little real sharing of patient's medical records across providers also results in increasing incidence of redundant tests and of treatments that are done in lieu of each new doctor have timely access to a patient's complete medical records. In addition, as the Institute of Medicine summarized in a 1999 report, lack of communication and information on patient medical conditions and history of drug reactions can be cited as a key reason that medical errors result in thousands of otherwise preventable deaths each year. On the provider side, there are economic pressures for providers to switch health affiliations due to poor business results or business insolvency of their current practice or affiliations or due to increasing frustration with reimbursement policies and cost-cutting practices of hospitals, HMOs and other health care groups.
FIG. 1 illustrates the fragmentation puzzle of a patient's medical records of the prior art. A patient has typically many healthcare providers over the patient's life, e.g., hospitals A and H, doctors B, C, D, and E, and other provides F and G (e.g., providers of Chiropractic or Homeopathic medicine). Doctors B and C illustrate by overlap area 110 the case when two healthcare providers share some, but not all their medical records. If two healthcare providers share all their records then for the purposes of this application, they are considered to be the same healthcare provider. In addition a patient may keep her own files.
FIG. 2 is a block diagram of an example flow of a patient's medical records among different healthcare providers of the prior art, that results in the fragmentation puzzle of FIG. 1. FIG. 2 illustrates that a partial transfer, or in some cases no transfer, of a patient's records from one healthcare provider to another causes more and more fragmentation of a patient's medical history over a patient's lifetime. While in this example, for illustration purposes, medical records are described as transferred between health care providers, the records are actually transferred from one health care provider's medical record repository or filing system to another health care provider's medical record repository or filing system. In this example, a patient begins with a general practitioner 110, e.g., a pediatrician, when the patient was a child. The patient then has general practitioner 112 as an adult. General practitioner 112 thinking that it was too long ago, decides not to request past medical records from general practitioner 110 and instead relies on a patient interview to fill in the patient's medical history. As a patient's memory is often fuzzy and a poor substitute for clinical information, general practitioner 112 gets an incomplete picture of the patient's childhood medical history. General practitioner 112 may send the patient to a specialist 114, e.g., a surgeon for an appendectomy. The specialist 114 gets some of the patient's medical records from general practitioner 112 (path 113a) and may also request other historical records from general practitioner 110 (path 118). The specialist 114 creates her own records and transfers all or most of these initial records, but not all ongoing records, back to general practitioner 112 (path 113b). The patient continues to see the specialist 114, at times without the General Practitioner 112. The ongoing updates by the specialist 114, after the initial introduction, are usually not managed and so any new information accumulated on the patient would most likely not be communicated back to General Practitioner 112. General practitioner 112 meanwhile continues to add new records as he continues to care for the patient. When the patient moves to a new general practitioner 120, for example, because of moving, changing jobs or switching to a health plan to which general practitioner 112 is not affiliated, the new provider will need access to the patient's medical history. As illustrated, the possible paths for general practitioner 120 to get a complete set of medical records is becoming complex. To get a complete medical history of the patient, general practitioner 120 needs medical records from general practitioner 110 (path 131), general practitioner 112 (path 130) and specialist 114 (path 132). However, to reduce costs and because of the delay in getting the records, general practitioner 120 may only request some “needed” records from general practitioner 112 (path 130) and no records from general practitioner 110 (path 131) or specialist 114 (path 132). If general practitioner 120 refers the patient to specialist 122, then specialist 122 has many paths, i.e., 121a, 134, and from which he may need medical records. However, specialist 122 may, to cut costs, only request the patient's medical records from general practitioner 120 (path 121a). Note that at this point no single provider necessarily has complete records on all patient medical care. Thus as this example indicates, as a patient goes from healthcare provider to healthcare provider, the patient's medical records often get more and more fragmented. Further, at some point, practitioners will discard the patient's medical records and vital information may be forever lost and will not be available at a critical time.
Several prior art systems have tried to solve the fragmentation problem by providing a centralized computer storage area available to the patient for storage of some of a patient's medical records. However, these prior art systems only store a small subset of a patient's medical history. Most examples of these prior art systems are Electronic Medical Record (EMR) systems that have scope and function limited to the portion of the patient's records corresponding to only that provider's care. One system allows a patient or his doctor to fax in to the central repository copies of the patient's medical records under their control. Some minimal organization of the scanned images is done manually by the patient, e.g., putting certain images in a patient's emergency folder and the rest in a general folder. As the number of images gets large, this very limited organization of the scanned images does not allow for timely retrieval of a relevant subset by a doctor currently treating a patient. In addition, because the patient, not a medical records technician, medical professional, or health service entity, selects what is to be placed in the emergency folder, some of relevant data may be omitted. Thus this system has both the disadvantages of a very incomplete patient history and limited usefulness of the images because the patient is forced to make decisions about the relevancy of certain medical information.
A patient's health is best served by a complete or nearly complete set of medical records with a comprehensive organizational structure used throughout. In contrast, prior art systems only provide a small subset of the patient's medical records within organizational structures that are likely to be inadequate to the needs and the time pressures of a healthcare provider currently diagnosing and treating the patient: the vast majority of the patient's medical records remain fragmented over the rest of the patient's many past and present healthcare providers. Prior art systems which provide the ability to consolidate a patient's medical records from the past do not provide meaningful or comprehensive organization for the patient's consolidated medical records. What is needed is a method and system that manages a complete or nearly complete set of a patient's medical records that allows easy retrieval and meaningful display of relevant information.